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Being Alive
"Nor Cruel and Unusual Punishments Inflicted"
Richard H. Rhodes
February 5, 1992
Being Alive 1992 Feb 5: 11

Those famous words from the Eighth Amendment of the United States Constitution have been violated many times in the past, and the tradition continues with a vengeance. While we are approaching the supposedly most enlightened era in modern history, the 21st Century, prisoners across the US are afraid for their very lives. They're not afraid of assaults from fellow inmates or guards, although they frequently happen, nor are they afraid of rejection from the parole board. They are fearing for their lives because of AIDS.

AIDS is the leading cause of death among inmates in New York prisons and is rapidly approaching this crisis level in other states because the nationwide AIDS policies of correctional institutions are often cold and contradictory. This AIDS policy is shrouded in obscurity and ambiguity. Many prison officials choose to ignore the crisis, while others force HIV+ inmates to be segregated for "their own safety," (according to one prison administrator in Mississippi). It is estimated that 18.5% of New York's prisoners are HIV+.

Dr. Robert Greifinger, chief medical officer of New York State, says that the prison system's "health care is adequate." However, the statistics would seem to suggest something else entirely. The true situation, according to Judy Greenspan of the ACLU's prison project, is that the New York State prison system's health care is "seriously substandard." This rings true when compared with reports by the Correctional Association of New York which have found that staffing in institutional facilities is inadequate, and that prison physicians generally lack a basic knowledge of HIV/AIDS, let alone knowledge of how to treat it. In fact, in 1987, 25% of all AIDS deaths in the New York prison system went undiagnosed until death that is if they didn't miss any! The substandard health care spoken of by Judy Greenspan is very much evident today. In two New York prisons this year, 12 inmates (all were said to be HIV+) and one guard have died from what has been labeled as a "new drug-resistant strain of tuberculosis." What makes this case damnable is the fact that even this "drug-resistant" strain of TB is treatable if it is properly identified! As sad as the situation is, this is only the beginning, the proverbial tip of the iceberg. TB cases increased 31% between 1989-90 in the New York prison system. Further, of the 25,701 cases of TB reported nationwide, New York's prison system commands an overwhelming 16% of these cases with 4,186, excluding this year.

While in other state prison systems, these statistics are not as high as in the New York prison system, there are other factors which weigh heavy on the inmates who have HIV. For example, in Mississippi, prison officials say that approximately 1.5% of incoming inmates test positive for HIV through their mandatory testing policy. This is roughly the same amount as the total estimated national infection rate. However, contrary to the facts on the spread of HIV, these HIV+ inmates are separated from the prison population and subjected to a variety of abuses from lack of educational opportunities to inadequate medical care. Basically, this means being locked in a small cell for approximately 23 hours a day until....

The National Commission on Acquired Immune Deficiency Syndrome blasted the nation's correctional facilities for their failure to "take advantage of the prison setting as a pivotal public health opportunity to educate for prevention of HIV disease, and begin humane care for those already infected." The Commission further said that "no other institution in this society has a higher concentration of people at substantial risk of HIV infection." The neglect of prison officials in administering health care was well stated in the commission's report, and the Vice Chairman of the commission, David E. Rogers, M.D., noted that "health and medical care of prisoners has always been low priority, and nothing highlights this more than the large amounts of HIV infection and resulting illness in our prisons." The commission made seven major recommendations. In substance they are: - The U.S. Public Health Service should develop guidelines for the prevention and treatment of HIV disease in all federal, state and local correctional facilities.

- Federal and state correctional officials should in particular assess and address conditions of confinement, adequacy of health care delivery systems, HIV education programs, and the availability of HIV testing and counseling for incarcerated women, incarcerated youth and children born in custody.

- A program such as the national Health Corps should be created to attract health care providers to work in correctional systems.

- The Department of Health and Human Services should issue a statement clarifying the federal policy on prisoners' access to clinical trials and investigational new drugs.

- Meaningful drug treatment must be made available on demand inside and outside correctional facilities.

- Prison officials should ensure that both inmates and correctional staff have access to comprehensive HIV education and prevention programs.

- Bar associations and entities such as the Federal Judicial Center must establish programs to educate judges, judicial clerks, and court officers about HIV disease.

Except in certain instances (e.g. the New York prison system) official statistics show that the spread of AIDS in prisons runs parallel with that of the outside community. Whether or not these official statistics are correct has not been confirmed by an independent agency. The only optimistic sign is that AIDS education, which is probably the single most important issue in curbing the spread of AIDS, is beginning to catch on with prison administrators. However, it will have little effect as long as prison administrators continue to segregate and ostracize inmates with HIV/AIDS. And as long as officials continue to ignore the critical subject of proper health care for these inmates, the crisis will continue to grow, and it will continue to constitute cruel and unusual punishment.

(Richard H. Rhodes has been HIV+ for two years and is a federal prisoner at the federal penitentiary in Leavenworth, Kansas. He would like to hear from anyone with comments or information at the following address: Reg. No. 05353-018, P.O. Box 1000/BL-210, Leavenworth, KS 66048.)

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